Heart Failure - Diary of a Third Year Medical Student

[maxxor]

Funny, I read it differently. I read it more as him being shell-shocked at the dehumanizing experience that MS-3 is. Not necessarily of doing things, per say, but the toxic work environment.

I mean, there's a huge amount of that too. I rotated at many of the hospitals he was at; not much has changed. All these "protections" we supposedly have amount to nothing. Because of all the extra mandatory stuff we have to do (primary care continuity clinic, class, etc), I would frequently get pulled from wards. I had residents get mad at my frequent absences, despite having given reminders that "hey, I have required primary care this afternoon, so I won't be around after rounds", and put derogatory "unprofessional; frequently disappears in the afternoons" comments into my evaluations. Sure people don't yell to my face, but I frequently would get it behind my back, even though they would say "great performance this rotation, maxxor" to my face.

Amusingly, he almost reads like the protagonist of House of God, except he had no fat man to guide him.

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[DermViser]

I mean, there's a huge amount of that too. I rotated at many of the hospitals he was at; not much has changed. All these "protections" we supposedly have amount to nothing. Because of all the extra mandatory stuff we have to do (primary care continuity clinic, class, etc), I would frequently get pulled from wards. I had residents get mad at my frequent absences, despite having given reminders that "hey, I have required primary care this afternoon, so I won't be around after rounds", and put derogatory "unprofessional; frequently disappears in the afternoons" comments into my evaluations. Sure people don't yell to my face, but I frequently would get it behind my back, even though they would say "great performance this relation, maxxor" to my face.

Amusingly, he almost reads like the protagonist of House of God, except he had no fat man to guide him.

Oh, ok, I didn't know you went to his med school. That was what I was meaning with respect to protections (i.e. mandatory lectures, etc.) from the wards. Were you able to have those comments/evals removed?!?! Yup, another instance of the professionalism hammer being abused - you can thank medical school Ivory tower academia. I agree, it's a lot more passive-aggressive now, bc outright yelling is somewhat no longer tolerated.

 

[maxxor]

Oh, ok, I didn't know you went to his med school. That was what I was meaning with respect to protections (i.e. mandatory lectures, etc.) from the wards. Were you able to have those comments/evals removed?!?! Yup, another instance of the professionalism hammer being abused - you can thank medical school Ivory tower academia. I agree, it's a lot more passive-aggressive now, bc outright yelling is somewhat no longer tolerated.

I didn't say I went to the same med school . The hospitals here have affiliations with multiple med schools. Attendings are dual credentialed. Any of the 3 med schools in the city could potentially have rotated at those hospitals.

 

[MedWonk]

I'd always be afraid of inadvertently getting a boner and it being obvious.

Has happened before. Spent the next 5-10 minutes alternating between a Captain Morgan stance and tying my shoe.

 

[Instatewaiter]

Hopkins trained you well. I think it's funny that you actually believe the attending's comment about how well he "connected" with patients vs. I don't know, what the actual patient thought themselves, just bc he refused to play Kabuki theater. Also, @Instatewaiter, he graduated with Honors from Tufts, and practices Family Medicine.

You're damn skippy hopkins trained me well. I'd much rather a doctor be an ass and be good at what he does than hold my hand and kill me with their incompetence. When people see me, they are dying. Literally. This isn't some mole that needs to be removed. They are circling he drain quickly and it is my job to stop them from reaching the bottom of that drain. When there is time for pleasantries great. I am rather personable, believe it or not and my patients love my straight forward attitude. When someone comes in with a STEMI or cardiogenic shock, I'm not waxing poetic about their relationship with their mother or the difficult time they are having at work. I'm getting the bare essentials to keep their ass alive before I shove a 6 french sheath in their leg.

As to this Michael Greger interacting well with patients remember he's the one telling the story. The fact that he's reporting the fact he was taken aside a few times lets you know it was much worse than he reported. The only time attendings, especially chiefs take a medical student asside it is because they are doing a terrible job. That this happened twice and he says he graduated with honors is suspect. I bet his grades from peds and surgery were terrible. Note he isn't AOA. Hmm...

Also, he doesn't practice family medicine. He is a general practitioner who is not boarded and didn't finish a residency.

 

[DermViser]

You're damn skippy hopkins trained me well. I'd much rather a doctor be an ass and be good at what he does than hold my hand and kill me with their incompetence. When people see me, they are dying. Literally. This isn't some mole that needs to be removed. They are circling he drain quickly and it is my job to stop them from reaching the bottom of that drain. When there is time for pleasantries great. I am rather personable, believe it or not and my patients love my straight forward attitude. When someone comes in with a STEMI or cardiogenic shock, I'm not waxing poetic about their relationship with their mother or the difficult time they are having at work. I'm getting the bare essentials to keep their ass alive before I shove a 6 french sheath in their leg.

As to this Michael Greger interacting well with patients remember he's the one telling the story. The fact that he's reporting the fact he was taken aside a few times lets you know it was much worse than he reported. The only time attendings, especially chiefs take a medical student asside it is because they are doing a terrible job. That this happened twice and he says he graduated with honors is suspect. I bet his grades from peds and surgery were terrible. Note he isn't AOA. Hmm...

Also, he doesn't practice family medicine. He is a general practitioner who is not boarded and didn't finish a residency.

I could be wrong, but Michael Greger does not seem to be the insufferable type to brag about being AOA if he was. I doubt he would lie again on his CV about graduating with honors from Tufts: http://humanesocietyuniversity.org/academics/cas/animalstudies/cvs/GregerCV.pdf

Contrary to popular opinion, being an *** and being good aren't mutually exclusive. To say you're only allowed one or the other is a huge copout and you know it. Patients are more than just things you do procedures to/on.

 

[Instatewaiter]

I doubt he would lie again on his CV about graduating with honors

Contrary to popular opinion, being an *** and being good aren't mutually exclusive. To say you're only allowed one or the other is a huge copout and you know it. Patients are more than just things you do procedures to/on.

I saw the cv. I couldn't find the honors designation on tufts website other than research honors. Which big whoop.

I think you are trying to say that being nice and good at doctoring aren't mutually exclusive. I agree. However in my experience being a whinny bit#h and being good are mutually exclusive. You don't have to be a dick to get stuff done but if you're a self righteous little turd, that gets in the way of you even be a reasonable doctor. I can honestly say that i have never met anyone who is as touchy-feely as this guy is who is even an average doctor. They are universally bad in my experience.

 

[evilbooyaa]

A bunch of QQing, although since he graduated back in '99, things may have been this bad. While I have experienced a certain amount of patient **** talking that he mentions in this tirade, at least at my hospital, it's nowhere near this bad (or at least they didn't let me hear about it nearly that much).

That being said, I've definitely made fun of patients behind closed doors (like a 400lb person having mild resp. issues due to TFTB - Too Fat To Breathe), but that's more to vent about the fact that we're stuck taking care of this person (which I know we signed up for, etc. etc.) than anything else.

Maybe I'm a dick. What I do know is this guy is sensationalistic.
"If everybody has a problem with you, then you are the problem".

All this being said, the bit about the comments on the unconscious (likely anesthetized, IMO) 5 year old girl kind of creeped me out. I know @Winged Scapula doesn't think anything of them (although she accepts she may be desensitized), but I don't think I could ever call a 5-year old girl anything more than 'cute' (not in the sense of cute < hot for adults) or 'adorable'. I would personally never call a 5-year old girl a 4th generation baywatch or anything that sexualized her in anyway.

 

[username456789]

I could be wrong, but Michael Greger does not seem to be the insufferable type to brag about being AOA if he was. I doubt he would lie again on his CV about graduating with honors from Tufts: http://humanesocietyuniversity.org/academics/cas/animalstudies/cvs/GregerCV.pdf

Contrary to popular opinion, being an *** and being good aren't mutually exclusive. To say you're only allowed one or the other is a huge copout and you know it. Patients are more than just things you do procedures to/on.

AOA has an easily searchable online database of all members. He is not an AOA member.

 

[Shjanzey]

This is the second thread about a book by a previous Med Student who is critical of the system. I note that both have a striking similarity in that neither of them finished a residency. To me that fact really diminishes their credibility.

Did I ever tell you (and everyone else) about the PGY3 on Transplant?

So I'm the intern; our 3 had apparently put on some weight during residency but had neglected to upsize his scrubs.

This bothered the female attending quite a bit but she didn't want to embarrass him by saying something so asked me to.

That was fun, being the intern and approaching your senior resident to talk about the fact that his scrubs were so tight that it was distracting to the attendings (the nurses chimed in that it bothered them as well) and NOT in a good way.

I think an experience like this would be enough to traumitize my 3rd year more than anything else.

 

[TooMuchResearch]

I know this sounds stupid, but punching someone for kicking me in the balls might result in me being expelled for being unprofessional. so I wouldn't punch.

Self defense is not unprofessional behavior.

 

[TooMuchResearch]

Yes, of course it's not universal, but just bc you tell the clerkship director in advance, there is absolutely no guarantee that he will delete the comments said about you from your MSPE, since subjective evaluations are used to calculate your grade. The MSPE is a letter of evaluation not a recommendation.

It's sort of an evaluation, but keep in mind he medical school has good reason to make you look good and see you match.

 

[TooMuchResearch]

Qft.

Guys, next time you're wearing scrubs, just look down every now and again. You'll pretty much feel liberated once you realize how visible things have been this whole time.

I fixed it for you.

 

[KanyeWes]

Self defense is not unprofessional behavior.

I agree. But this is med school. you have no leverage and ppl can sink your career even if you are right. Rem, there is such a thing as being dead right

 

[DermViser]

Self defense is not unprofessional behavior.

If you haven't figured out, as a medical student you have no leverage. The word "unprofessionalism" can destroy your career. Heck it's sometimes thrown at attendings to destroy their careers.

 

[DermViser]

This is the second thread about a book by a previous Med Student who is critical of the system. I note that both have a striking similarity in that neither of them finished a residency. To me that fact really diminishes their credibility.

I don't see how whether or not they continue GME is relevant to what he points out.

 

[PL198]

Self defense is not unprofessional behavior.

That's not self defense. There's no imminent thread that the doctor is going to beat you down and hurt you. If they crack you in frustration and then that's it, there's no more threat and you can't just wail on them. Not to mention just because something is legally acceptable doesn't mean it's tolerated by an institution.

I'll say this again, the only justifiable reason to hit back in that situation is if there is still a threat. Doubt an attending is going to get into a throw-down in the hospital, highly.

 

[CherryRedDracul]

If you haven't figured out, as a medical student you have no leverage. The word "unprofessionalism" can destroy your career. Heck it's sometimes thrown at attendings to destroy their careers.

This. And also punching is not valid self-defense after the fact (of being kicked in the balls). If the attending is chasing you around the hospital trying to kick your balls, then it's a different story.

Otherwise, punching is retaliation, not self-defense.

EDIT: Welp, PL198 covered what I said.

 

[PL198]

This. And also punching is not valid self-defense after the fact (of being kicked in the balls). If the attending is chasing you around the hospital trying to kick your balls, then it's a different story.

Otherwise, punching is retaliation, not self-defense.

EDIT: Welp, PL198 covered what I said.

This is why I have a bromance with you, though I'm not sure if it's unrequited or not.

 

[CherryRedDracul]

This is why I have a bromance with you, though I'm not sure if it's unrequited or not.

<3

 

[DermViser]

This is why I have a bromance with you, though I'm not sure if it's unrequited or not.

LOL! Me too! Don't know if it's unrequited with him or not. Although his current avatar gives me the creeps a little.

 

[PL198]

I get what you guys are saying in regards to it being retaliatory vs self-defense but I think you need to evaluate your opinion that being nailed in the nuts is a benign thing.

"However, in one study, Buckley and McAninch (2006) reported that 46% of patients presenting with blunt scrotal trauma underwent surgical exploration and were found to have rupture of the tunica albuginea"
http://emedicine.medscape.com/article/441362-overview

It's not that it's benign. It can have tremendously negative effects, but the point is that there is no existing thread after that takes place. You can only defend yourself legally if there is a feeling of threat.

 

[DermViser]

It's not that it's benign. It can have tremendously negative effects, but the point is that there is no existing thread after that takes place. You can only defend yourself legally if there is a feeling of threat.

I'm always amazed by medical students who believe that somehow they are protected by their medical school. Do you actually think your medical school won't be more than happy to throw you under the bus even if you are in the right, vs. a resident or medical school faculty member? Unless it's an accusation of sexual assault, as a medical student you have absolutely NO protections and no whistleblower protections.

Heck, even ATTENDINGS don't have whistleblower protections and get the words "unprofessional" and other tactics thrown at the them to destroy their careers:

http://www.boston.com/lifestyle/hea...r-bias-suit/zXyke5jXn2Oztrgp04KzeN/story.html

http://www.thecrimson.com/article/2009/2/26/doctor-found-guilty-in-lawsuit-the/

 

[PL198]

Dude if a male medical student claimed sexual assault and was assaulted, I honestly bet it would be worse for them results wise than just dealing with being sexually assaulted and nothing said about it. Change that situation out for a female and it's like you're Charlie at the chocolate factory and the whole world opens up to you.

If you're a male in modern society, you're f*cked. If you're a medical student in modern society, you are f*cked. If you are a male medical student in modern society, you are f*cked ^2

 

[DermViser]

Dude if a male medical student claimed sexual assault and was assaulted, I honestly bet it would be worse for them results wise than just dealing with being sexually assaulted and nothing said about it. Change that situation out for a female and it's like you're Charlie at the chocolate factory and the whole world opens up to you.

If you're a male in modern society, you're f*cked. If you're a medical student in modern society, you are f*cked. If you are a male medical student in modern society, you are f*cked ^2

Normally I would agree with you, but if a medical student is able to establish that they followed the proper protocol after the sexual assault and still nothing was done about it, or even worse the school retaliated, then he would make a killing with a lawsuit. Medical schools/medical centers are not rolling in money to pay out that kind of cash.

 

[RJGOP]

Dude if a male medical student claimed sexual assault and was assaulted, I honestly bet it would be worse for them results wise than just dealing with being sexually assaulted and nothing said about it. Change that situation out for a female and it's like you're Charlie at the chocolate factory and the whole world opens up to you.

If you're a male in modern society, you're f*cked. If you're a medical student in modern society, you are f*cked. If you are a male medical student in modern society, you are f*cked ^2

Yeah it's the bull$hit notion of the war on women. The liberals victimize women in attempt to negatively taint the Republicans as insensitive or anti-women. Inevitably, and unfortunately, that propaganda has carried over into the "real world" and that's why you hear about all of this empowering women b/c they're so mistreated and disadvantaged. Wake up, it's 2014!

 

[DermViser]

Uh what? What I see is people getting paid a lot of money for the stupid crap other physicians, who were hospital employees, did. Not sure what you're trying to demonstrate here. Not saying it would work for me personally.

My point was that you have no protections, period, as a medical student. Even as a physician you still have to be careful, bc your institution is more than happy to throw you under the bus.

 

[DermViser]

Yeah it's the bull$hit notion of the war on women. The liberals victimize women in attempt to negatively taint the Republicans as insensitive or anti-women. Inevitably, and unfortunately, that propaganda has carried over into the "real world" and that's why you hear about all of this empowering women b/c they're so mistreated and disadvantaged. Wake up, it's 2014!

Or accuse of the other side not paying women for "equal pay, for equal work" meanwhile the White House was found to be paying women much less than men in the same position.

 

[RJGOP]

Or accuse of the other side not paying women for "equal pay, for equal work" meanwhile the White House was found to be paying women much less than men in the same position.

Just a classic example pure hypocrisy.

 

[PL198]

And as I stated, I would then present to the ED for medical evaluation, have it all documented by the emergency department staff, call the police on the way there, and have him/her arrested for assault. You think the hospital wants the headline "Local physician assaults medical student" with the insert "Dr. So and so was arrested by police last night for allegedly assaulting a medical student by kicking him in the testicles" on the front page the next day? I think not.

Well yeah and that's all the smart course of action, but I'm confused if you're still advocating for physically retaliating or not.

 

[Siggy]

Yeah it's the bull$hit notion of the war on women. The liberals victimize women in attempt to negatively taint the Republicans as insensitive or anti-women. Inevitably, and unfortunately, that propaganda has carried over into the "real world" and that's why you hear about all of this empowering women b/c they're so mistreated and disadvantaged. Wake up, it's 2014!

[youtube]

 

[evilbooyaa]

Wait, how did this go from "Woe is me, the poor MS3" to "Women suck, and all the issues they have to deal with are immediately balanced out by the fact that sexual assault on males is slightly less common and less reported! OMG, Liberals suck and are super hypocrites!"

I know I'm exaggerating a bit, but the fact that males have it bad in one aspect of life (sexual assault reporting rates) doesn't mean it's worse to be a male medical student than a female medical student.

 

[DermViser]

Wait, how did this go from "Woe is me, the poor MS3" to "Women suck, and all the issues they have to deal with are immediately balanced out by the fact that sexual assault on males is slightly less common and less reported! OMG, Liberals suck and are super hypocrites!"

I know I'm exaggerating a bit, but the fact that males have it bad in one aspect of life (sexual assault reporting rates) doesn't mean it's worse to be a male medical student than a female medical student.

To be fair, the author of the book graduated medical school in 1999, and apparently, nothing has really changed on rotations from then to now (according to an SDNer above). But that's neither here nor there.

According to this: http://jama.jamanetwork.com/article.aspx?articleid=201513
Male physicians have an increased rate of suicide at 70% compared to males in the general population (AND in the male professional subset), while female physicians have an increased rate of suicide of 250% - 400%, vs. other women. So IMHO, females in medicine have it much worse.

 

[Freddie Mercury]

I wonder how much of the difference is attributable to a difference in suicide success rates between physicians and non physicians. A doctor knows which drugs or combination is more deadly, where to cut which artery, etc. Maybe they have similar attempt rates, but physicians succeed more often?

 

[PL198]

Wait, how did this go from "Woe is me, the poor MS3" to "Women suck, and all the issues they have to deal with are immediately balanced out by the fact that sexual assault on males is slightly less common and less reported! OMG, Liberals suck and are super hypocrites!"

I know I'm exaggerating a bit, but the fact that males have it bad in one aspect of life (sexual assault reporting rates) doesn't mean it's worse to be a male medical student than a female medical student.

Lol it was a slight detour. I'd say assuming your soapbox was a bigger one. I highly disagree with you, but whatever it's not the point of this thread.

 

[evilbooyaa]

Lol it was a slight detour. I'd say assuming your soapbox was a bigger one. I highly disagree with you, but whatever it's not the point of this thread.

... while I would like to discuss this further just to understand what you could possibly mean, I agree that this is not the thread to do it in.

 

[TooMuchResearch]

If you haven't figured out, as a medical student you have no leverage. The word "unprofessionalism" can destroy your career. Heck it's sometimes thrown at attendings to destroy their careers.

Leverage is irrelevant. Workplace violence is unacceptable. If someone is actively assaulting you, then actively defend. Then immediately escalate to someone that won't brush it aside/cover it up.

 

[TooMuchResearch]

I agree. But this is med school. you have no leverage and ppl can sink your career even if you are right. Rem, there is such a thing as being dead right

You're either joking or are a massive pushover. A whipping boy, if you will. "I'd defend myself, but it would be unprofessional." Really?

 

[DermViser]

Leverage is irrelevant. Workplace violence is unacceptable. If someone is actively assaulting you, then actively defend. Then immediately escalate to someone that won't brush it aside/cover it up.

And if you actively assault back (as was mentioned by someone previously) you will be sent to your Dean's office and either suspended or have your MSPE destroyed for "unprofessionalism" which is a scarlet letter for residency selection. It's your choice.

 

[TooMuchResearch]

And if you actively assault back (as was mentioned by someone previously) you will be sent to your Dean's office and either suspended or have your MSPE destroyed for "unprofessionalism". It's your choice.

I'm not talking about someone hitting you and walking away. That requires immediate, non-violent responsive action.

 

[DermViser]

I'm not talking about someone hitting you and walking away. That requires immediate, non-violent responsive action.

Even if it's more than once. Always remember: "They can always hurt you more".

 

[PL198]

I'm not talking about someone hitting you and walking away. That requires immediate, non-violent responsive action.

Ok cool. Do you want to next talk about what you're going to do if one of your professors stops in the middle of lecture and walks over to you and punches you in the face? We can talk about unicorns while we're at it. The chances of a physician actually attempting to beat the crap out of you is honestly probably less than your chance of winning the lottery.

 

[TooMuchResearch]

Okay no I can't agree with you there. If someone strikes me once, I'm going to the administration and police about it. If someone continues to actively assault me, I'm going to defend myself while attempting to remove myself from the room. If defending myself requires that I strike them back to allow myself to leave and immediately report the situation, that's what's going to happen. You don't get a license to beat down people just because you're an attending. This is of course all purely theoretical (I hope).

If your stupid house of god quote is how you convince yourself you're not a b*tch while you nurse that black eye and bruised rib then go ahead.

Agreed.

 

[TooMuchResearch]

Ok cool. Do you want to next talk about what you're going to do if one of your professors stops in the middle of lecture and walks over to you and punches you in the face? We can talk about unicorns while we're at it. The chances of a physician actually attempting to beat the crap out of you is honestly probably less than your chance of winning the lottery.

Hey, man, you're the one responding to the thread. The thread in which quotes/links about this actually occurring are posted.

Just for clarification, do you not think about things that are very unlikely to occur?

 

[PL198]

Hey, man, you're the one responding to the thread. The thread in which quotes/links about this actually occurring are posted.

Just for clarification, do you not think about things that are very unlikely to occur?

No, if you would have read the thread, I already said retaliation is only acceptable when there is an ongoing threat. Obviously no one is going to sit there and let someone kill them or continue to injure them. Thank you for stating the obvious though. I'm pretty sure there hasn't actually been a single source about a situation where a student would need to physically retaliate..

 

[Siggy]

I wonder how much of the difference is attributable to a difference in suicide success rates between physicians and non physicians. A doctor knows which drugs or combination is more deadly, where to cut which artery, etc. Maybe they have similar attempt rates, but physicians succeed more often?

That's what we were told during psych. Suicide attempt rates are about even between physician and non-physician. Completed suicides, on the other hand, are much higher for physicians.

 

[DermViser]

Okay no I can't agree with you there. If someone strikes me once, I'm going to the administration and police about it. If someone continues to actively assault me, I'm going to defend myself while attempting to remove myself from the room. If defending myself requires that I strike them back to allow myself to leave and immediately report the situation, that's what's going to happen. You don't get a license to beat down people just because you're an attending. This is of course all purely theoretical (I hope).

If your stupid house of god quote is how you convince yourself you're not a b*tch while you nurse that black eye and bruised rib then go ahead.

With all due respect, you agreeing really isn't relevant. I agree, you are free to defend yourself. But any situation is always a he said/she said situation, unless there is some video camera recording of the situation. When you throw a punch, you lose any recourse. As a medical student you have no power.

 

[KanyeWes]

The problem here is that med schools are not unbiased. Their primary directive is to protect themselves. Not to help you or to serve justice.

So, if you punch and fight back, you have the potential to get screwed over by a judicial committee, which often comprises of a bunch of self righteous loser narks who get their revenge of the nerd justice by screwing you over.

Plus some schools Have a "zero tolerance" policy towards violence. So even if you are defending yourself against someone who is repeatedly assaulting you, you would lose and get kicked out because of that policy.

It doesn't make sense, but these school policies are designed .

 

[DermViser]

The problem here is that med schools are not unbiased. Their primary directive is to protect themselves. Not to help you or to serve justice.

Bingo. They have certain protocols in place for things like these.

 

[SouthernSurgeon]

The problem here is that med schools are not unbiased. Their primary directive is to protect themselves. Not to help you or to serve justice.

Yup.

Most med students don't realize this...because 99% of the time, the interests of the school and the interests of the student are aligned. When a student's interests run counter to the institutions...they quickly realize how little that institution cares about them.